Association of body composition, tumor-specific assessment, and patient demographics at diagnosis with 90-day and overall survival in esophageal cancer patients in a global population

This study seeks to define baseline variation and clinical correlates of body composition in a large international cohort of patients undergoing esophagectomy for cancer. Patients who underwent esophagectomy in 14 high-volume centers between 2007 to 2019 were eligible for inclusion. Skeletal muscle, visceral and subcutaneous adipose tissues within computer tomography images (L3 axial image), acquired routinely at diagnosis, were analyzed in accordance with a standardized protocol. In total, 1716 patients were recruited from three global regions: North America (22%), Europe (55%), and Asia (23%). Patients were predominantly male (79.5%) and adenocarcinoma was the most common histological subtype (66.6%). Characteristics significantly associated with levels of muscle and adiposity were global region, sex, age, and histological subtype (P < 0.001). Compared to adenocarcinoma, squamous cell carcinoma was associated with significantly lower levels of muscle and adiposity, a finding that was independent of global region, sex, and age using a multivariable linear regression model (P < 0.001). Reduced skeletal muscle and an excess of total adiposity at diagnosis was associated with increased 90-day mortality and reduced long-term survival. A prediction model including skeletal muscle, total adiposity at diagnosis and other tumor and patient specific variables was constructed to allow convenient survival prediction. This study adopts a standardized method to define international variation in parameters of body composition in esophageal cancer patients. Findings provide clinically relevant information regarding operative mortality and overall survival and can inform future guidelines for the use of body composition assessment in routine clinical practice.